Healthcare and the Free Market
How should a free market work in Healthcare?
First off, you have to agree that healthcare is a service oriented business where the patient is actually receiving something for the money that gets spent. If you cannot agree on this point, the rest is a mute issue.
In a totally free market, any trade is usually conveyed by freely fluctuating prices and supply and demand. Most medical care could be considered optional as many problems are self-limited. People can choose to treat long term conditions knowing the consequences of their decision. Catastrophic illnesses or accidents are not typically by choice and provisions need to be made for “insurance” for these less common events.
History has shown that medical care in essentially voluntary markets tends to be accessible and affordable for the vast majority of patients. The sustained price inflation we have witnessed over the past 50 years is the result of direct or indirect political intervention.
Competition between providers today is not what is considered free market competition. Providers do not compete for the satisfaction of the actual consumer of care, the patient, but it is the politically created competition from overregulation and 3rd party entities (Insurance companies). Taking the actual consumer out of the equation has created these tremendous costs. For free trade to actually exist the participants in the exchange (the doctor and the patient) must be the legitimate owners of the goods and services exchanged.
Whether the liberals want to admit it or not, medical care is an individual service consisting of the skilled assistance from a healthcare provider directly to a patient for the benefit of recovering from an illness or prevention of an illness.
During the past 50 years when patients were taken out of the mix and no longer had to pay for the service (many companies paid 100% of the insurance), medical care became commodity that most people took for granted. Historically, medical care ranked way below nourishment, sanitation, education, entertainment, and so on but when it was free for so many years and for so many people, it became the expectation that it was deserved and someone else should be paying for it.
Even today, most medical treatments can be deferred for various periods of time, and spontaneous healing often takes place. Lifestyle choices can markedly affect the susceptibility to illness and the ability to heal and certainly can effect the cost of fixing problems.
But if the free market was allowed to work and everyone understood that this is a service oriented business, most routine medical care could be paid for by individuals and families. Insurance would only be needed for catastrophic events and individuals could choose supplemental plans that fit their needs for things other than routine visits.
Yes this change would entail sacrifices. Entertainment, cigarettes, cell phones, cable TV, eating out, etc. may have to be weighed against going to the doctor for a minor illness. But these same choices are made when you look to buy a house, a car, go to your lawyer or accountant or have your automobile repaired. For too many years, financial choices have been made for virtually everything except healthcare.
From personal experience, my patients who have transitioned to MSA’s or HSA’s have increasing become better consumers of healthcare. They understand the costs and they are willing to evaluate the pros and cons of every decision and recommendation. They are also willing to ask for discounts and other options to treat their conditions. The internet has made information readily available and most patients are well informed.
Yes we need changes, but universal healthcare is not the answer. Individual responsibility and putting patients back in charge of the finances of healthcare is the only way to fix the broken system.
First off, you have to agree that healthcare is a service oriented business where the patient is actually receiving something for the money that gets spent. If you cannot agree on this point, the rest is a mute issue.
In a totally free market, any trade is usually conveyed by freely fluctuating prices and supply and demand. Most medical care could be considered optional as many problems are self-limited. People can choose to treat long term conditions knowing the consequences of their decision. Catastrophic illnesses or accidents are not typically by choice and provisions need to be made for “insurance” for these less common events.
History has shown that medical care in essentially voluntary markets tends to be accessible and affordable for the vast majority of patients. The sustained price inflation we have witnessed over the past 50 years is the result of direct or indirect political intervention.
Competition between providers today is not what is considered free market competition. Providers do not compete for the satisfaction of the actual consumer of care, the patient, but it is the politically created competition from overregulation and 3rd party entities (Insurance companies). Taking the actual consumer out of the equation has created these tremendous costs. For free trade to actually exist the participants in the exchange (the doctor and the patient) must be the legitimate owners of the goods and services exchanged.
Whether the liberals want to admit it or not, medical care is an individual service consisting of the skilled assistance from a healthcare provider directly to a patient for the benefit of recovering from an illness or prevention of an illness.
During the past 50 years when patients were taken out of the mix and no longer had to pay for the service (many companies paid 100% of the insurance), medical care became commodity that most people took for granted. Historically, medical care ranked way below nourishment, sanitation, education, entertainment, and so on but when it was free for so many years and for so many people, it became the expectation that it was deserved and someone else should be paying for it.
Even today, most medical treatments can be deferred for various periods of time, and spontaneous healing often takes place. Lifestyle choices can markedly affect the susceptibility to illness and the ability to heal and certainly can effect the cost of fixing problems.
But if the free market was allowed to work and everyone understood that this is a service oriented business, most routine medical care could be paid for by individuals and families. Insurance would only be needed for catastrophic events and individuals could choose supplemental plans that fit their needs for things other than routine visits.
Yes this change would entail sacrifices. Entertainment, cigarettes, cell phones, cable TV, eating out, etc. may have to be weighed against going to the doctor for a minor illness. But these same choices are made when you look to buy a house, a car, go to your lawyer or accountant or have your automobile repaired. For too many years, financial choices have been made for virtually everything except healthcare.
From personal experience, my patients who have transitioned to MSA’s or HSA’s have increasing become better consumers of healthcare. They understand the costs and they are willing to evaluate the pros and cons of every decision and recommendation. They are also willing to ask for discounts and other options to treat their conditions. The internet has made information readily available and most patients are well informed.
Yes we need changes, but universal healthcare is not the answer. Individual responsibility and putting patients back in charge of the finances of healthcare is the only way to fix the broken system.
Labels: healthcare
posted by Anonymous at 5:45 AM
17 Comments:
I am sorry, Doctor, but health care is not a luxury such as cigarettes, cell phones, cable TV or eating out.
You said people should put off being seen for minor illness. What about preventative care? If people let a condition continue it could very well turn into a major illness. As Ben Franklin said "A penny saved is a penny earned". I think this also applies to a person's health. We need to see about small problems before they become major problems.
Universal health care IS the only answer.
I agree, Shirley.
I find it hard to believe that HB would personally turn away someone in need of medical care based on their income or claim that doing so is the moral thing to do.
I'm confused, then, as to why he continues to insist that our entire medical system should be set up to facilitate that very thing.
First let's get some definitions. Health care is not an accurate description of what the public has come to expect. The public wants prepaid wellness assurance, and that it be inexpensive. That is impossible to deliver at any price. Don't kid yourself believing otherwise.
Sickness insurance is what people need, and for the types of services they anticipate needing. The more services expected the more the price of the product.
Unless one believes in slavery you are not entitled to the skills of HB or any other provider. You are not able to avail yourself of anyone elses time and skills just because you want or need them. Otherwise that is immoral and ammounts to slavery. That includes the notion that the majority can set the price by law for which one offers their skills. This is NOT a democracy but a constitutional republic, or it used to be one.
Ms. Baird,
Health care is a service that is provided by a physician and/or other provider. Preventative care is important and I highly recommend it to all of my patients. But it also is a service that individuals can choose to spend money on or not.
For many people they choose not to unless it is paid for by someone else. I did not say individuals should put off minor illnesses; only that they could choose to. Many things I see in the office everyday could be treated at home with time and OTC medications to see if it improves. I would be willing to bet that your parents did not take you to the doctor nearly as often as parents take their kids today for things other than routine shots.
I will treat anyone who comes to the office but it is a service and there should be the expectation from the individual receiving the service that there is a cost that has to be paid. We have a minimum charge for persons without any insurance and it is $30. For patients with really difficult situations I still see them for absolutely nothing.
I believe the comments from anonymous are exactly correct.
Health care is a right, not a luxury.
The free-market system proposed by the doctor would be a system for the very rich (even upper middle class incomes can no longer cope with the cost of (for-profit) insurance.
Besides, just look at Wall Street's banking system to see how well the free market "functions". We can't afford to bail out any more businesses.
Single-payer health care is the only sensible RX for our poor health care system. It is cost-efficient, lets patients and physicians determine the course of health care without insurance company interference, allows patients to choose their own care-givers, is simple, and would be available equally to all.
Above all, a government-funded health care system has as its goal the delivery of health care, while the present private insurance system has as its goal the making of profits.
If drastic changes are not made to our present health care "system", by 2025 the insurance and out-of-pocket costs for an average family will equal their entire income.
The only system proposed which would deliver good health care to everyone, would be cost-effective, fair and efficient, would be a publicly-funded but privately-delivered system, as proposed in H.R. 676.
After seeing how well the free market worked in the banking business, I can't see it being any better in the health care field.
And, we just can't afford to bail out yet another inefficient, whining corporation.
Speaking of definitions, anyone who voluntarily decides to join a profession and gets paid for doing so is not a slave.
There has been no suggestion that anyone be forced against their will to become a medical professional, held in bondage, and not paid for their work.
For a doctor to say that such comments are "exactly correct" is deeply disturbing.
Sorry, but anyone whose compensation for their time and services is involentarily imposed upon them by one or more other parties is a slave! If someone chooses to function under your rules, well that's their life, but because you insist your "rights" impose an obligation upon someone else deminishes the second parties rights. Your rights end at my doorstep! You may not impose a positive obligation upon me or anyone else, like a doctor.
The notion that Wall Street is or has recently been "free market" only reveals ignorance, not necessarily stupidity. The Federal Reserve Bank and the congress plus the executive branch of government from all recent administrations have combined to give us this mess.If one wishes to learn some economics from sources other than the New York Times I recommend FEE.org. Give yourself about two weeks of open minded reading and rethink your positions. Health care ( if that is what you insist on calling it) has not been "free market" for at least 60 years. The price of medical/surgical services have been rising faster than the cost of living for the past 40+ years, ever since medicare distorted the market further after the tax provisions from FDR that took insurance from the service consumer and put it in the hands of other parties and obscured the price. Add to that the mandated coverages from rent-seaking imposed by state government and the "market" was left behind long ago along with price regulation of supply/demand.
Hello! There is so much misinformation and mythology here -(not to mention the "mute"? point) one doesn't know where to start. Sounds like the Rush Limbaugh/Ayn Rand Business School of Medicine has some disciples.
We have been trying for national health care since Harry Truman's plea to Congress in 1949. It's way past time. It was not Government that created over 2000 administrative nightmare, beuracratic, for-profit insurance companies that siphon off much of the nearly 16% of our GDP spent on health care. (highest in the world - for quality and delivery of care behind about 36 other countries). The for-profits' administrative costs(marketing, exorbitant CEO salaries, shareholders, etc. etc.) are much, much higher than the approximate 3%of Medicare overhead. Most seniors who receive Medicare are quite happy with it. They still have their choice of doctor and hospital, which is what HR 676 (i.e. Medicare for All) proposes - a plan that is privately delivered, but publicly administered, with the costs and risk spread among the entire population, including the healthy young, resulting in much lower per patient costs. Single-payer is now favored by a majority of the public and by physicians.
All this talk about the "consumer" is so much marketing B.S. (and I am retired from a career in advertising and marketing, so I know it when I see it.) Health care is not Pepsi and should not be marketed as if it were a competing brand. As Shirley said, health care is not a luxury item. It is a necessity for life, liberty, and the pursuit of happiness.
The insurance companies provide nothing in the way of health care. In fact, they get "in the way" of providing health care. They make their money in two ways: increasing premiums, deductibles, and co-pays, and/or denying claims. How/whom does that help? They need to be out of the mix. They'll be plenty of health care jobs available in the new system - caring for 48 million new enrollees. Check out www.hr676.org and get the scoop.
Medicare is bankrupt, not efficient. It has future debt that dwarfs what has everyone upset over Wall Street.
A-mous:
Have you noticed the whole country is bankrupt? Thanks to an unregulated free market, which is an invitation to greed and piracy.
Medicare is still more efficient and cost-effective, despite the ridiculous and wasteful "commissions" that the Fed pays for private insurers to sell the unnecessary "Advantage" plans. Just look at the expensive full page ads and all those TV commercials you have been seeing - and will see until the end of March - from Humana et al trying to push seniors to buy these "bundled" Medidcare plans. Thankfully, these will soon be gone.
A complete overhaul of the health care system is needed and is about to happen. And if we can get a Medicare for All single payer plan, it won't be limited to covering only the high usage elderly ill. Medicaid would be eliminated,as will the enormous costs of the overuse of the ER as a primary care facility. Don't you realize that we who have insurance (or think we have insurance) are already paying for the uninsured? Really, doesn't it make more sense to stop pretending our "free market" system isn't badly broken and just get to work to make sure all our people have access to affordable, quality health care? After all, when you're sick, you can't work. And when you put off seeking health care at the early stages of illness, the costs and risk increase exponentially.
Welcome to communism and comrad Ruthanne. She admitts she didn't like the work she did for evil market capitalism. Will you give back your ill gotten gains? And by the way, if you were defrauding the public while working in the "free market" you should be prosecuted.
I agree with HB!
No one is going to get care with universal healthcare unless you get approval from the government. If you are over the age of 60 or an unborn child you have no rights! oh but hey if you are in prison or choose not to work we will take care of you! Time will tell all and people are going to be unhappy, but I am afraid then it will be too late.
I am one of those parents who take my kids in. To me it is worth $25 to know what is going on instead of guessing or worrying. That is my choice and not a right and I have no problem paying my Dr.
We have great healthcare for the most part. Yes it needs some help, but universal heathcare is not the answer. Our doctors work hard and are well educated. That will change, who is going to want to work that hard for the government to tell them how to treat their patients.
I appreciate my doc and I think he deserves what he is paid and then some. I think people forget the years of school doctors have to have and the money it costs. The hrs they put in as interns and as physicians. They are having to put in more hrs and see more patients for the same amount of money they earned in previos yrs. When Obama is done it will only get worse and we will lose some of the excellent doctors and we will have average docs and as time goes on it will get worse.
I don't think people realize the citizens from other contries that have Universal Healthcare come here for medical care.
A-Mous:
Argumentum ad hominum non et rem.
You are apparently out of material and still misinformed. Single-payer (HR 676) provides for DOCTOR CHOICE. The doctors remain private and are NOT employees of the government (That would be the current VA System, which is completely run by the Government, where the medical staff are employed by the government, and the hospital is owned by the government.) And, while some foreigners may come here for specialized care, they are required to purchase insurance to do so. In contrast, many Americans travel to other countries for surgeries - including Mexico for excellent and affordable dental care.
Yes, we have great health care - if you have a lot of money. Meanwhile, half of all bankruptcies in the U.S. are due to medical bills.
And all this fearmongering about "the Government" neglects the fact that the government is US.
P.S. Someone who lacks the courage to own their words (i.e. sign their name) doesn't warrant any credibility.
Ruthanne
Comrade Ruthanne
I am far from out of material, it is just that I will never change your closed mind. Your side is likely to prevail. It is the individual that will lose as their choices are limited and they will never be allowed to peacefully go back.
As to my electing to respond anonymously, well, that is an option H.B. offers and I choose. Kind of like the "card check" debate.I can guess which side of that debate you support.
Regarding some specifics:
3% overhead. Do you really believe that? The federal government has a 3% overhead of any program! Studies have shown the true overhead is likely on the order of 25% +/-.
37th in world health care ranking is from the WHO, an U.N. sponsored organization. The criteria they apply have a bias toward single payer health plan. They do not consider treatment outcome as a criteria. In other words if everyone gets the same rotten care that is rated higher than excellent outcome unevenly distributed among a population. While excellent care for all is a goal it has a price that is unavoidable.
Treatment outcome is the only valid judgement of the sickness care given. In this the USA is the best or near best in all measured criteria. Infant mortality rates are not valid for several reasons among them the fact that live birth statistics are not reported uniformly among all nations. Life expectancy is influenced by far to many other factors to be attributed to the sickness care system. Even hospital death stastics are invalid since in many nations with single payer systems people are denied hospitalization and die elsewhere.
The notion that the single payer government ins. will not change anything else is rediculous. HB is not a fool. If his compensation is controled by one source and his costs are still his, he will have eventually no choice but to quit or become an employee of the payer. One's loyalty is with the one who writes the check, and patients will no longer have an advocate. ALL similar systems of care in the world eventually ration care. Ours now does also, but the government will be the sole determiner of that care.
There is no such thing as a free lunch!
Doctors are not slaves. Slaves did not sell a house for over $400,000 to move up to a larger one.
The invocation of the slave trade in this context is reprehensible, to say nothing of a member of a learned profession endorsing same.
What has the value of a persons house have to do with anything? Was the money earned honestly? if so, what do you or anyone else have to say about how well someone lives? We now no longer aspire to do better in the USA, or is it that only certain persons are allowed to so aspire and achieve.
Slavery is being denied the freedom of self determination of the value of one's labor. It might be outright ownership of one person by another, but the use of anothers labor at imposed price by a government is also meeting the broad definition. I doubt when HB went to medical school he anticipated the government directly or indirectly would determine his value without his input. Sure, he can always quit, at least for now, but his self determination is restricted by outside forces claiming ownership of his skills.
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